拉丁美洲儿童念珠菌血症的主动监测：改善疾病结局的关键要求。
Active surveillance of candidemia in children from Latin America: a key requirement for improving disease outcome.
机构信息
From the *Department of Pediatrics, Hospital Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile; †Hospital Escuela, Tegucigalpa, Honduras; ‡Hospital de Clinicas, Universidade Federal do Parana, Curitiba, Brazil; §Infectious Diseases Unit, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; ¶Hospital Vozandes, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador; ‖Hospital de Clínicas José de San Martín, Buenos Aires, Argentina; **Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, Colombia; ††Infectious Diseases Unit, Department of Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; ‡‡Infectious Unit, Hospital Vargas, Caracas, Venezuela; §§Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; ¶¶Department of Medicine, Universidad Cayetano Heredia, Lima, Perú; and ‖‖University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
出版信息
Pediatr Infect Dis J. 2014 Feb;33(2):e40-4. doi: 10.1097/INF.0000000000000039.
BACKGROUND
Active surveillance is necessary for improving the management and outcomes of patients with candidemia. The aim of this study was to describe the epidemiologic and clinical features of candidemia in pediatric patients in Latin America.
METHOD
Prospective, multicenter, surveillance study of candidemia in a pediatric population from 23 hospitals in 8 Latin America countries between November 2008 and October 2010.
RESULTS
Three hundred and two cases of candidemia were reported with a median incidence of 0.81/1000 admissions. Eighty nine (29%) were neonates. The main risk factors were prematurity, intensive care unit (ICU) admission, parenteral nutrition, respiratory disease and mechanical ventilation in neonates and malignancy, neutropenia, neurological disease and previous use of corticosteroids in children. The main species isolated in neonates and children were Candida albicans (43.8% and 35.7%), Candida parapsilosis (27.0% and 26.3%) and Candida tropicalis (14.6% and 14.6%), respectively. The most frequent antifungal therapy used in neonates and children was deoxycholate-amphotericin-B (43.8% and 29.1%) and fluconazole (28.1% and 53.1%). Seventeen neonates (19.1%) and 20 children (9.4%) did not receive antifungal therapy. The 30-day survival rate was 60% in neonates and 72% in children (P = 0.02). Survival was significantly higher in treated than in nontreated neonates (72% vs. 24%; P < 0.001). A multivariate analysis showed that independent predictors for 30-day mortality in children were renal disease (odds ratio: 4.38, 95% confidence interval: 1.92-10.1, P < 0.001) and receipt of corticosteroids (odds ratio: 2.08, 95% confidence interval: 1.04-4.17, P = 0.04).
CONCLUSIONS
To our knowledge, this is the first prospective, multicenter surveillance study of candidemia in children in Latin America. This epidemiologic information may provide us with methods to improve preventive, diagnostic and therapeutic strategies in our continent.
背景
主动监测对于改善念珠菌血症患者的管理和预后是必要的。本研究的目的是描述拉丁美洲儿科患者念珠菌血症的流行病学和临床特征。
方法
这是一项在拉丁美洲 8 个国家的 23 家医院进行的关于儿科人群念珠菌血症的前瞻性、多中心监测研究。
结果
报告了 302 例念珠菌血症病例，中位发病率为每 1000 例入院患者 0.81 例。89 例（29%）为新生儿。主要危险因素为早产、重症监护病房（ICU）入住、肠外营养、新生儿呼吸疾病和机械通气以及儿童恶性肿瘤、中性粒细胞减少症、神经疾病和皮质类固醇的先前使用。在新生儿和儿童中分离出的主要菌种分别为白色念珠菌（43.8%和 35.7%）、近平滑念珠菌（27.0%和 26.3%）和热带念珠菌（14.6%和 14.6%）。在新生儿和儿童中最常使用的抗真菌治疗分别为去氧胆酸盐两性霉素 B（43.8%和 29.1%）和氟康唑（28.1%和 53.1%）。17 名新生儿（19.1%）和 20 名儿童（9.4%）未接受抗真菌治疗。新生儿 30 天生存率为 60%，儿童为 72%（P=0.02）。接受治疗的新生儿生存率明显高于未接受治疗的新生儿（72%比 24%；P<0.001）。多变量分析显示，儿童 30 天死亡率的独立预测因素为肾脏疾病（优势比：4.38，95%置信区间：1.92-10.1，P<0.001）和皮质类固醇的使用（优势比：2.08，95%置信区间：1.04-4.17，P=0.04）。
结论
据我们所知，这是拉丁美洲首例关于儿科患者念珠菌血症的前瞻性、多中心监测研究。这些流行病学信息可能为我们在本大陆提供改善预防、诊断和治疗策略的方法。
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